A sense of duty appears to be driving the common practice of coming to work with the flu among resident physicians, researchers found.

A survey found 51% to have worked with flu-like symptoms at least once in the prior year and 16% to have worked sick at least three times over the same period, Anupam B. Jena, MD, PhD, of Harvard and Massachusetts General Hospital in Boston, and colleagues reported.

The top-cited reason was an obligation to colleagues (57%), closely followed by obligation to patient care (56%), the group noted in a research letter released online in the Archives of Internal Medicine.

“The practice of presenteeism by resident physicians raises important questions about the development of professionalism in young physicians,” they wrote.

But the findings likely extend to all clinicians, Deborah Grady, MD, of the University of California San Francisco, suggested in an accompanying editor’s note.

“Working while sick may demonstrate an admirable sense of responsibility to patients and colleagues, but clinicians also need to worry about the real danger of infecting vulnerable patients as well as colleagues and staff,” she argued.

Making sure the hospital has adequate coverage and guidelines on working when ill may help, but faculty also need to make sure that residents learn that the most professional way to care for patients is to refrain from working while sick, Jena and colleagues wrote.

They agreed with Grady that pressure to work while ill is common across healthcare.

The demand on physicians in small practices is particularly strong, because they may have little alternative to rescheduling patients since they don’t have a pool of colleagues to draw on - like teaching hospitals typically have - to cover residents who can’t come in for reasons like illness, Jena noted in an interview with MedPage Today.

Some patients in that case actually prefer to take their chances with infection over waiting another month or two for a rescheduled appointment, he pointed out.

In a hospital setting, too, there can be some benefits to patient care from working though sick, such as keeping the physician most familiar with details of a case, Jena noted.

Nevertheless, “the quality of care would probably be slightly improved if fewer residents come in sick,” he said.

To look at reasons for presenteeism, the group surveyed 150 residents attending an Illinois chapter meeting of the American College of Physicians from 20 internal medicine programs in the state.

Their anonymous responses suggested a trend for second-year residents to report working with flu-like symptoms more than first-year residents (58% versus 51%, P=0.51).

This trend fit with sense of obligation as a driver of presenteeism, because more senior residents usually shoulder more responsibility for unifying care for a team’s patients and thus may feel greater pressure to come in regardless of how terrible they feel, the researchers pointed out.

Women tended to report presenteeism more often than their male colleagues (56% versus 48%, P=0.22) and also tended to cite patient care as the reason for doing so (60% versus 46%, P=0.21).

Fear of being seen as “weak” if one stayed home when sick wasn’t endorsed as a reason for working through the flu by many residents, but women tended to be more likely to report this reason (18% versus 7%, P=0.16).

Just 8% of the residents overall said they worked sick because they felt pressured to repay colleagues for covering for them.

“We don’t know how sick the residents in this survey were, but it probably doesn’t matter much, since being afebrile is not a very specific test for lack of infectiveness,” Grady noted.

Primary source: Archives of Internal Medicine
Source reference: Jena AB, et al “Why physicians work when sick” Arch Intern Med 2012; DOI:10.1001/archinternmed.2012.1998.

Additional source: Archives of Internal Medicine
Source reference: Grady D “I just feel terrible” Arch Intern Med 2012; DOI:10.1001/archinternmed.2012.2063.

###

By Crystal Phend, Senior Staff Writer, MedPage Today